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3a > Paediatrics: Renal/Urinary/Urology > Flashcards

Paediatrics: Renal/Urinary/Urology Flashcards

1
Q

what structures are in the urinary tract ?

A
  • urethra
  • Bladder
  • Ureters
  • Kidneys
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2
Q

What is acute pyelonephritis ? leads to ?

A

it is when infection affect tissues of the kidney => scarring => reduced kidney function

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3
Q

What 2 things could confirm the diagnosis of pyelonephritis ?

A
  • Temp >38
  • Loin pain/tenderness
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4
Q

What is cystitis ?

A

inflam of the bladder (can be due to infection)

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5
Q

What is the most common cause of UTI ? be specific

A

most caused by bacterial organism from GI tract
- E.Coli (most common)

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6
Q

Name symptoms of UTI in babies ? (7)

A
  • Fever (often the only symptom)
  • lethargy
  • Irritabilty
  • VOmiting
  • Reduced feeding
  • Urinary frequency
  • Failure to thrive
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7
Q

what investigations would you do for suspected UTI ?

A
  • Clean catch sample
  • Microscopy and culture
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8
Q

explain the expected results of a clean catch urine sample for suspected UTI ?

A
  • nitrites
  • Leukocytes
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9
Q

describe why there would be nitrites in urine in a UTI ? what causative organism ?

A

gram -ve bacteria (echericha coli) breakdown nitrates (normally found in urine) to nitrites

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10
Q

urine sample showed negative nitrites and positive leukocytes. What do you do ?

A
  • don’t assume or treat its a UTI
  • only leukocytes raised so most likely vulvovaginitis
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11
Q

What do leukocytes in urine suggest ?

A

can be small amounts normally but rise suggest infection of inflammation

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12
Q

presentation of older infants + children with a UTI ?

A
  • Fever
  • Abdo pain
  • Vomiting
  • Dysuria
  • Frequency
  • Incontinence
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13
Q

Management of UTI in a baby < 3 months ?

A
  • All children <3months: start immediate IV Abx (ceftriaxone)
  • Septic screen (blood cultures, bloods, lactate, consider LP)
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14
Q

Management of UTI in children > 3months ?

A
  • Oral Abx (trimethoprim, nitrofurantoin)
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15
Q

When would you admit a child with UTI ? what would you do ?

A
  • under 3 months
  • if septic
  • if pyelonephritis
    admit + IV Abx
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16
Q

Would investigations would you do for someone with Recurrent UTIs ? to look for what ?

A
  • US scan (I think to look for renal scarring)
  • Micturating cysourethrogram (MCUG) (VUR)
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17
Q

What does a micturating cystourethrogram (MCUG) assess ?

A

assess for vesico-ureteric reflux (VUR)

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18
Q

What is vesico-ureteric reflux (VUR) ? cause of what ?

A

urine ahs tendancy to flow from the baldderback to the ureterus => upper UTI => renal scarring
- cause of recurrent UTIs

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19
Q

Managmetn of vesicle-ureteric reflux (VUR) ? (2)

A
  • Avoid constipation or excessively full bladder
  • Consider prophylactic Abx
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20
Q

What is vulvovaginitis ?

A

it is inflammation + irritation of the vulva + vagina

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21
Q

In who is vulvovaginitis common ?

A

common condition affecting girls between 3 - 10 yrs

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22
Q

what is vulvovaginitis caused by ?

A

caused by sensitive + thinned skin + mucosa around vulva + vagina in young girls

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23
Q

what exacerbates vulvovaginitis ?

A
  • Wet nappies
  • Chemical soaps
  • Tight clothing (traps sweat)
  • Poor toilet hygeine
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24
Q

why does vulvovaginitis affect pre-pubertal girls ?

A

at puberty: oestrogen helps keep vagina + skin healthy so prevents it

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25
Q

vulvovaginitis presentation ?

A
  • soreness, itching
  • erythema
  • vaginal discharge
  • Dysuria
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26
Q

What would be seen on urine dipstick for vulvovaginitis ?

A

may show leukocytes nut no nitrites
(don’t misdiagnose as UTI)

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27
Q

vulvovaginitis management ?

A
  • Avoid washing with harsh soaps
  • Keep area dry
  • Good toilet hygiene
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28
Q

What is nephrotic syndrome ?

A

It is when the basement membrane in the glomerulus becomes highly permeable to protein => allows protein to leak from blood into urine

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29
Q

classic triad nephrotic syndrome ?

A
  • Low serum albumin
  • Raised protein urine content (>3+ on urine dipstick)
  • Oedema
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30
Q

other features of nephrotic syndrome ? apart from classic triad

A
  • deranged lip profile
  • raised BP
  • hypercoagulability
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31
Q

Nephrotic syndrome presentation ? age ?

A

age 2 - 5
- Frothy urine
- generalised oedema
- Pallor

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32
Q

What is the most common cause of nephrotic syndrome in children ?

A

minimal change disease
(cause in 90% of children)

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33
Q

What is minimal change disease

A

nephrotic syndrome without any clear underlying pathology

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34
Q

What will be seen on urinalysis in minimal change disease ? (2)

A
  • small molecular weight proteins
  • Hyaline casts
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35
Q

what will be seen on renal biopsy in minimal change disease ?

A

will not detect any abnormalities

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36
Q

Management of minimal change disease ?

A
  • Corticosteroids (prednisolone)
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37
Q

minimal change disease prognosis ?

A

most children make a full recovery

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38
Q

Would can cause nephrotic syndrome in children ? (3)

A
  • Minimal change disease (90%)
  • Intrinsic kidney disease: focal segmental glomerulosclerosis
  • secondary to systemic illness: HSP, diabetes, infection
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39
Q

what are podocytes ?

A

specialised epithelial ells of the glomerular BM

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40
Q

oedema differential ? (4)

A
  • Nephrotic syndrome
  • HF
  • Allergic reaction
  • Malnutrition
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41
Q

Nephrotic syndrome management ?

A
  • High dose corticosteroids (prednisolone)
  • Low salt diet
  • Consider dietetics for oedema
  • Prophylactic Abx (due to leak of immunoglobulins)
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42
Q

Nephrotic syndrome complications ? (3)

A
  • Hypovolaemia
  • Thrombosis
  • Infection
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43
Q

explain how nephrotic syndrome could cause hypovolaemia ?

A

as fluid leaks form intravascular space to interstitial space => oedema and low BP

44
Q

explain how nephrotic syndrome could cause thrombosis ?

A

proteins that normally preven clotting are lost though kidneys => low albumin => liver produces prothrombotic proteins => hyper coagulable state

45
Q

explain how nephrotic syndrome could cause infection ?

A

kidney leaks immunoglobulins + immunosuppressed by steroid treatment

46
Q

2-5 year old child with oedema, proteinuria + low albumin. What is the underlying cause ?

A

nephrotic syndrome due to minimal change disease

47
Q

What is Henoch-Schonlein Purpura (HSP) ? age ?

A

It is an IgA vasculitis that presents with a purpuric rash affecting lower limbs + buttock
- in kids <10

48
Q

what causes the inflammation in HSP ?

A

inflam occurs in affected organs due to IgA deposits in the blood vessels

49
Q

what is HSP often triggered by ? (2)

A

often triggered by upper airway infection of gastroenteritis

50
Q

HSP presentation: 4 classic features ? how common is each

A
  • Purpura (100%)
  • Joint pain (75%)
  • Abdo pain (50%)
  • kidney impairment (50%)
51
Q

what causes the purpura in HSP ?

A

inflam _ leading of blood from small blood vessels

52
Q

what can the abdo pain in HSP lead to ? (2)

A
  • GI haemorrhage
  • Intussception
53
Q

Describe the kidney impariemtn in HSP ? what does it cause ?

A

IgA nephritis => haematuria + proteinuria => nephrotic syndrome

54
Q

causes of a non-blanching rash (5)

A
  • Meningococcal sepsis
  • Leukaemia
  • HSP
  • ITP
  • Haemolytic uraemia syndrome
55
Q

How is HSP diagnosis made ?

A
  • Exclude meningococcal septicaemia + leukaemia
    Palpable purpura PLUS:
  • Diffuse abdo pain
  • Arthritis/arthralgia
  • IgA deposits on renal histology
  • Proteinuria or haematuria
56
Q

HSP management ?

A

supportive management with simple analgesia + hydration

57
Q

What is enuresis ? during day ? night ?

A

it is involuntary urination
- nocturnal enuresis: bedwetting
- Diurnal enuresis: daytime

58
Q

When do most children gain continence ? day ? nigh ?

A

most children get daytime urination control by 2 and nightimte by 3-4 urs

59
Q

what is primary nocturnal enuresis ?

A

child has never managed to be consistently dry at night

60
Q

most common cause of primary nocturnal enuresis ?

A

variation in normal development
(reassure)

61
Q

causes of primary nocturnal enuresis ? (6)

A
  • variation in normal dev
  • Overactie bladder
  • Fluid intake (prior to bed, fizzy drinks)
  • Failure to wake up (due to deep sleep + undeveloped bladder signals)
  • Psychological stress
  • Secdonary causes
62
Q

describe the behaviour in overactive bladder that causes primary nocturnal enuresis ?

A

frequent small volume uriantion prevents development of bladder capacity

63
Q

What secondary causes could cause primary nocturnal enuresis ? (4)

A
  • Chronic constipation
  • UTI
  • LD
  • CP
64
Q

Management for nocturnal enuresis ?

A
  • Bladder diary
  • lifestyle changes (fewer fluids in evening, pee before bed)
  • Encouragement + positive reinforcement (no blame + shame or punishment)
  • treat underlying cause
  • enuresis alarms
  • pharmacological treatment
65
Q

how does an enuresis alarm work ?

A

device that makes noise at first sign of bed wetting
- need to be used consistently for 3 months

66
Q

what pharmacoligcla management could be used for nocturnal enuresis ?

A
  • Desmopressin (vasopressin (ADH) analogue): reduce col of urine produced by kidneys
67
Q

what pharmacological management could be used for overactive bladder ?

A
  • oxybutinin (anticholinergic): decrease contractility of bladder
68
Q

What is secondary nocturnal enuresis ? more indicate of what ?

A

child starts wetting bed after being dry for 6 months
- more indicitat of an underlying illness

69
Q

what could cause sedentary nocturnal enuresis ?

A
  • UTI
  • Constipation
  • T1DM
  • Psychosocial problems
  • maltreatment
70
Q

what 2 types of diurnal enuresis is there ?

A
  • Urge incontinence (overactive bladder)
  • Stress incontinence
71
Q

What is Wilms tumour ? what age group ?

A

it is a tumour that affects the kidneys in children <5yrs

72
Q

wilms tumour presentation ?

A
  • parents may comment on amass in the Childs abdo
  • abdo pain
  • haematruia
  • Lethargy
  • Hypertension
  • Weight loss
73
Q

investigations for Wilms tumour ? diagnostic ?

A
  • US-KUB
  • CT or MRI: to stage the tumour
  • Biopsy to identify the histology (definitive diagnosis)
74
Q

how is Wilms tumour managed ?

A
  • Surgical excision: of the tumour and the affected kidney
  • Adjuvant chemo + radiotherapy
75
Q

What is another term for undescended testes ?

A

cryptochiadism

76
Q

what is cryptochiadism ?

A

undescended testes
- congenital acscne of one or both testes in the scrotum (failure of descent into the scrotum)

77
Q

when and how should the testes usually descend ?

A

in utero: normally the testes develop in the abode and then gradually migrate down through inguinal canal => scrotum (prior to birth)

78
Q

what are ectopic testes ?

A

testis is present but not found along the normal pathway of descent

79
Q

what can undescended testes lead to if unresolved ?

A

higher risk of
- testicular torsion
- Infertility
- testicular cancer

80
Q

undescended testes RF ? (4)

A
  • FHx of undescended testicles
  • Low birth weight, SGA
  • Premature
  • maternal smoking
81
Q

Undescended testes management ? when should you do something ?

A

cryptochiadism
- usually will descend in 3-6 months
- 6-12 months: surgical correction (orchidopexy)

82
Q

What is hypospadias ?

A

It is a congenital condition affecting males, where the urethral meatus (urethral opening) is abnormally displaced to the under side of the penis

83
Q

how common is hypospadias ?

A

around 1/300 births (male)

84
Q

describe some of the features of hypospadias ?

A
  • ventral opening of urethral meatus
  • Ventral curvature of penis (cordee)
  • Dorsal hooded foreskin
85
Q

Hypospadias management ? how urgent? do not do what ?

A
  • Referral to paediatrics specialist
  • Do not circumsize
  • Surgery after 3-4 months age (to correct positions of meatus)
86
Q

Complications of hypospadias ? (3)

A
  • Difficulty direction urination
  • Cosmetic/psychological
  • Sexual dysfunction
87
Q

What is hydrocele ? what structure involved ?

A

it is a collection of fluid within the tunica vaginilis that surrounds the testes ?

88
Q

What is a simple hydrocele ?

A

fluid is trapped in the tunica vaginalis + gets reabsorbed over time

89
Q

what is a communicating hydrocele ?

A

tunica vaginalsis connected to peritoneal cavity => hydrocele fluctuates in size

90
Q

hydrocele most common presentation ?

A
  • Painless scrotal enlargement
91
Q

hydrocele examination ? (response to light)

A

it would transilluminate with light

92
Q

differential for scrotal or inguinal swelling ?

A
  • Hydrocele
  • Partially descended testes
  • Inguinal hernia
  • testicular torsion
93
Q

Hydrocele management ?

A
  • Simple hydrocele: usually resolve alone
  • Communicating: Surgical (in children >2yrs)
94
Q

What is testicular torsion ? what structures involved ?

A

It is twisting of the spermatic cord with rotting of the testicle (Surgical emergency)

95
Q

What can testicular torsion lead to ? (complications)

A

delay => increase risk of ischaemia + necrosis of testicle => subfertility + infertility

96
Q

testicular torsion presentation ?

A

teen patient playing sport
- Acute unilateral tisticular pain
- abdo pain
- N&V

97
Q

What could be found on examination of a patient with testicular torsion ?

A
  • Firm swollen testicle
  • Absent cremesteric reflex
  • Rotation (epididymis not in normal location)
98
Q

Testicular torsion investigations ? diagnostic ?

A
  • Clinical diagnosis - can go strain to surgery if suspected
  • If unsure: scrotal US
99
Q

testicular torsion management ? how quick does it need to be done ?

A

uro-emergency: urgent treatment within 4-6 hrs
- nil by mouth, analgesia
- Surgery: orchiopexy (correct position), orchidectomy (remove testicle)

100
Q

What is paraphemosis ? what does this lead to ?

A

It is the inability to pull forward a retracted foreskin over the glans penis => glans becomes increasingly oedematous (due to reduce venous return) => vascular engorgment of distal penis + further oedema

101
Q

what is phimosis ?

A

reverse of paraphimosis: cannot retract the foreskin over the glans

102
Q

what happens if paraphimosis is untreated ?

A

ischaemia + worsening infection => necrosis

103
Q

paraphimosis management:

A
  • Analgesia
  • Dextrose soaked gauze (osmotic effect => reduce oedema) plus manual pressure
104
Q

A 4 month old girl presents with a culture-proven E. coli UTI. She is treated with oral antibiotics, and responds well to treatment within 48 hours. What, if any, imaging is required in this case?

A

Ultrasound scan within 6 weeks

105
Q

In a 9 month old girl with presenting with UTI, when would a micturating cystourethogram be appropriate?

A

MCUG is not normally appropriate in this group
(appropriate from 12 months onwards)

106
Q

A child had repeated episodes of UTI as a child. What is the best method to investigate for renal scarring?

A

DMSA scan

107
Q
A

3a (43 decks)

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